Member Services

Application Form

    All boxes marked ‘required’ must not be left blank

    Membership number ※This will be notified at a later date.
    Name (required)
    (Family name + First name)
    Japanese Phonetics E-mail address (Please type in again)
    (Example) Suzuki Taro
    E-mail address (required) (Example)
    E-mail address (Please type in again) (required)
    Membership type (required)
    ※ Required only for Student Members.
    Graduating year and month (required) Year Month
    Affiliated laboratory (required)
    Form number
    (Example) Tozai University *Please fill out if necessary.
    Note) Please only fill out the name of the addressee of invoice etc.
    ※ Please fill out your postal address. (Your affiliation, etc., should be filled out in the "Remarks" column)
    Postal (zip) code (required)
    Example) 305-8573
    Prefecture/State (required)
    Postal address 1 (required)
    Postal address 2
    Postal address 3
    Example for Japanese address 1):
    Postal address 1: Setagaya-Ku Todoroki 1-2-3
    Postal address 2: Information and Media Studies, Tokyo University of Arts and Sciences
    Postal address 3: System Information and Media Studies
    Example for Japanese address 2):
    Postal address 1: 35-1 Monzencho enter west Muromachi Kamigyo-Ku, Kyoto City
    Postal address 2: Rakuyuh Residence No. 201
    Postal address 3: (blank)
    Phone number
    Date of Birth Year Month Day
    Remarks ※Please freely write anything including your affiliation, occupation, carrier, interests and expectations toward the Society. (250 words max)